不同节段的小肠旷置术治疗2型糖尿病的疗效及机制的对比研究

项目名称： 不同节段的小肠旷置术治疗2型糖尿病的疗效及机制的对比研究

项目编号： No.81500652

项目类型： 青年科学基金项目

立项/批准年度： 2016

项目学科： 医药、卫生

项目作者： 段金元

作者单位： 南昌大学

项目金额： 18万元

中文摘要： 小肠旷置术（JIB）是最早应用于临床的减重手术之一，手术在取得满意的减重效果的同时也显著缓解了并发的2型糖尿病（T2DM）。我们研究发现，和传统的端侧吻合法小肠旷置术（ESJIB）相比，侧侧吻合加捆扎法小肠旷置术（SSJIBL）具有操作更简单、疗效更佳的优点。有研究报道，不同节段的JIB均能改善T2DM。然而，究竟旷置哪一节段的SSJIBL治疗T2DM的疗效最佳还不明确。此外，SSJIBL治疗T2DM的具体机制也需更深一步研究。我们推测，SSJIBL术后T2DM的改善可能与肠道微生物菌群变化密切相关。本研究将以我们前期建立的SSJIBL为手术模型，分别对T2DM大鼠(GK大鼠)施以十二指肠旷置术、近端小肠旷置术、中段小肠旷置术、远端小肠旷置术四种不同的手术，来系统探讨不同节段的SSJIBL治疗T2DM的疗效及机制，为临床上应用和改进SSJIBL治疗T2DM提供理论依据。

中文关键词： 减重手术；2型糖尿病；小肠旷置术；肠道微生物

英文摘要： Jejunoileal bypass (JIB) was performed frequently as a bariatric surgical option for massive obesity and yielded significantly glycemic control with acceptable weight loss. Our previous studies found that side-to-side jejunoileal bypass plus proximal loop ligation (SSJIBL) induced better antidiabetic effects than end-to-side jejunoileal bypass (ESJIB) and SSJIBL is easier than ESJIB. Previous studies showed that jejunoileal bypass in different positions of small intestine all induced dramatic glucose-lowering effects. However, to date, very little systematic work has been done to study the comparison of curative effect between proximal intestinal bypass and mid intestinal bypass or distal small intestinal bypass on diabetes. Moreover, the mechanisms underlying this dramatic remission of T2DM following SSJIBL were not well understood. Furthermore, we assumed that changes of the gut microflora induced by physiological-anatomical changes might be a determinant of antidiabetic effects after SSJIBL. To investigate the above problems, we are going to develop four experimental intestinal procedures using the SSJIBL model, which was established by us. The four experimental intestinal procedures are duodenal-jejunal bypass (DJB), proximal small intestinal bypass (PSIB), mid small intestinal bypass (MSIB) and distal small intestinal bypass (DSIB), respectively. The antidiabetic effect of the four intestinal procedures and the changes of gut microflora of the T2DM rats will be then compared with each other to determine the contributions of the bypassed segment and the changed gut microflora to the improvement in glucose homeostasis after SSJIBL, which will provide experimental evidences for clinical application and modification of SSJIBL.

英文关键词： bariatric surgery; type 2 diabetes mellitus;jejunoileal bypass;gut microflora